The recent all-party parliamentary group’s report into hidden hunger and malnutrition in the elderly has shone a light on the epidemic of malnutrition being suffered by this country’s older population and the impact it is having on our health and social care systems.
No one knows the full extent of the problem. There is a generic estimation that one in 10 people over 65 are malnourished, or at risk of malnourishment, but the reality is that we just don’t know. Councils and their health partners need to ensure that, at all levels of care, staff are trained to use the Malnutrition Universal Screening Tool (MUST), or an equivalent mechanism, to identify older people who are at risk of malnutrition and understand the scale of the problem.
Councils should have a statutory duty of care to ensure that older people are getting a hot meal once a day, as a basic right. This is hugely important, not just to prevent human misery but also to lessen the impact on the NHS and social care services. Malnutrition amongst older people is estimated to cost our health and social care services £11.9bn annually, which will increase to £13bn in 2020 and £15.7bn by 2030.
Preventing an older person’s decline into malnutrition ought to be a key element of prevention. Yet there is a worrying trend towards cutting food-related services; they are seen as easy, low-hanging fruit providing a non-essential service.
The Food Train, a food shopping and delivery service for older people in North Ayrshire, Scotland recently had its funding withdrawn by the council. It supported 236 older people in need at a cost of £317.80 per person for the year; in comparison, a hospital stay costs £400 per day. Services such as Food Train also provide social contact, which helps to prevent another determinant of older people’s health: loneliness and social isolation.
It’s the same for meals on wheels services nationwide; gross expenditure on meals on wheels more than halved in the decade between 2003-04 and 2013-14 from £96m to £42m. Likewise, the number of older people in receipt of meals on wheels services declined by four fifths between 2005-06 and 2013-14, from 155,000 to 29,000.
What will it take for councils to accept they have a duty of care to ensure equity of access to food services like these for older people? It’s not acceptable for people to be living off sandwiches simply because they are unable to shop for and prepare their own food.
I’m very aware that funding has never been tighter but, as the report suggests, this isn’t a question of funding new schemes; it’s about using the money that’s available more wisely. Adult care services need to ring-fence the current spending on initiatives relating to feeding older people; whether that’s lunch clubs, meals on wheels or voluntary services delivering essential food related services.
As a society we should aspire to having community food services in every local area. Councils need to start seeing this in terms of social justice and health promotion, as well as looking at the longer term savings it will generate; it’s a problem that should no longer remain hidden.
Wendy Wills, professor of food and public health and director of the Centre for Research in Primary and Community Care, School of Health and Social Work, University of Hertfordshire